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投稿时间：2025-02-24 网络发布日期：2025-07-21
投稿时间：2025-02-24 网络发布日期：2025-07-21
中文摘要: 目的 探讨腹腔镜手术治疗结直肠癌后腹腔热灌注化疗（HIPEC）的效果，以及高迁移率族蛋白1（HMGB1）和晚期糖基化终产物受体（RAGE）水平变化，为临床治疗提供参考。方法 选取2021年5月至2024年3月太原市中心医院收治的152例接受腹腔镜手术治疗的结直肠癌患者，按照随机数字表法分为观察组（n=76）和对照组（n=76），其中对照组给予XELOX方案化疗，观察组在此基础上给予HIPEC。比较两组手术一般情况及恢复情况、疗效、肿瘤标志物［血管内皮生长因子（VEGF）、基质金属蛋白酶9（MMP9）、癌胚抗原（CEA）、糖类抗原199（CA199）］、免疫功能（CD3+、CD4+、CD8+、CD4+/CD8+）、HMGB1、RAGE、毒副反应及随访期间复发转移情况。结果 两组切口长度、手术时间、术中出血量、术后排气时间比较差异均无统计学意义（P＞0.05）；观察组总有效率高于对照组（88.16% vs 75.00%，P<0.05）；观察组化疗1、3个周期后血清CEA、VEGF、MMP9、CA199水平均低于对照组（P<0.02）；观察组化疗1、3个周期后CD3+、CD4+、CD4+/CD8+水平均高于对照组，CD8+水平低于对照组（P<0.02）；观察组化疗1、3个周期后血清HMGB1、RAGE均低于对照组（P<0.02）；两组毒副反应比较差异无统计学意义（P＞0.05）；随访6个月，观察组无病生存比例高于对照组（93.42% vs 82.89%，χ2=4.033，P<0.05）。结论 结直肠癌腹腔镜手术治疗后行HIPEC有良好疗效，可改善患者免疫功能，其作用可能与HMGB1/RAGE轴有关，且未明显增加毒副反应，有一定安全性。
Abstract:Objective To investigate the efficacy of hyperthermic intraperitoneal chemotherapy（HIPEC） after laparoscopic surgery for colorectal cancer and the changes in the high mobility group box 1（HMGB1）and receptor for advanced glycation end products（RAGE）， providing a reference for clinical treatment. Methods A total of 152 colorectal cancer patients who underwent laparoscopic surgery at Taiyuan Central Hospital from May 2021 to March 2024 were selected and randomly divided into an observation group（n=76）and a control group（n=76）using a random number table. The control group received XELOX chemotherapy ，while the observation group received additional HIPEC. The general surgical conditions，recovery condions，efficacy，tumor markers［vascular endothelial growth factor（VEGF），matrix metalloproteinase-9（MMP9），carcinoembryonic antigen（CEA），carbohydrate antigen 199（CA199）］，immune function（CD3+，CD4+，CD8+，CD4+/CD8+），HMGB1，RAGE，adverse reactions，and recurrence/metastasis during follow-up were compared between the two groups.Results There were no significant differences in incision length，operation time，intraoperative blood loss，or postoperative exhaust time between the two groups（P>0.05）. The total effective rate in the observation group was higher than that in the control group（88.16% vs 75.00%，P<0.05）. After 1 and 3 cycles of chemotherapy，serum levels of CEA，VEGF，MMP9，and CA199 in the observation group were lower than those in the control group（P<0.02）. After 1 and 3 cycles of chemotherapy，CD3+，CD4+，and CD4+/CD8+ levels in the observation group were higher than those in the control group，while CD8+ levels were lower（P<0.02）. Serum HMGB1 and RAGE levels in the observation group were lower than those in the control group after 1 and 3 cycles of chemotherapy（P<0.02）. There was no significant difference in adverse reactions between the two groups（P>0.05）. After 6 months of follow-up，the disease-free survival rate in the observation group was higher than that in the control group （93.42% vs 82.89%，χ2=4.033，P<0.05）. Conclusion HIPEC after laparoscopic surgery for colorectal cancer demonstrates good efficacy，improves immune function，and may be associated with the HMGB1/RAGE axis，without significantly increasing adverse reactions，indicating a certain level of safety.
keywords: Colorectal cancer Hyperthermic intraperitoneal chemotherapy Laparoscopic surgery High mobility group box 1 Receptor for advanced glycation end products Safety
文章编号： 中图分类号：R541.7 文献标志码：A
基金项目:山西省大健康产业高质量发展科研专项课题（DJKZXKT2023207）
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引用文本：
梁奇正，范悦，傅洋，李国栋.腹腔镜手术治疗结直肠癌后腹腔热灌注化疗的效果及HMGB1、RAGE水平变化[J].中国临床研究,2025,38(7):1020-1025.
梁奇正，范悦，傅洋，李国栋.腹腔镜手术治疗结直肠癌后腹腔热灌注化疗的效果及HMGB1、RAGE水平变化[J].中国临床研究,2025,38(7):1020-1025.